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Title:: Bone metabolism changes in patients with type 2 diabetes and their relationship with 25 - hydroxyl vitamin D3, parathormone

作者:: 陈松锦; 莫艳霞; 谢小菲; 东莞市人民医院内分泌科，广东东莞523126

Author(s):: CHEN Song-jin; MO Yan-xia; XIE Xiao-fei; Department of Endocrinology, Dongguan People's Hospital, Dongguan 523126, Guangdong, China Corresponding author: CHEN Song-jin, E-mail: chensongjin0328@163.com

关键词:: 2 型糖尿病; 骨代谢; 甲状腺旁激素; 25-羟维生素D3

Keywords:: Type 2 diabetes; Bone metabolism; Parathormone; 25-hydroxyl vitamin D3

分类号:: R722.12

DOI:: -

摘要:: 目的探讨骨代谢在2 型糖尿病患者中的变化情况及2 型糖尿病与25-羟维生素[25(OH)D3]、甲状腺旁激素（PTH）的关系。方法以350 例2 型糖尿病患者作为观察组进行研究，根据指标不同分为多个亚组：①将其按病程不同分为：观察A 组(病程≤10 年)190 例、观察B 组（病程＞10 年） 160 例；②根据糖化血红蛋白（HbA1c）水平不同分为：观察C 组(病程≤10 年，HbA1c＜7%)205 例、观察D 组（病程＞10 年， HbA1c＞7%） 145 例；③根据骨量分为：骨密度正常组102 例、骨量减少组161 例、骨质疏松症组87 例。另选同期进行健康体检者180 例作为对照组进行分析。均采用双能X 线骨密度仪测定其骨密度情况，同时检测其血钙、磷、镁、碱性磷酸酶、24 h 尿钙、25(OH)D3、PTH 水平情况。结果观察组25(OH)D3、血镁、股骨颈骨密度、全髋骨密度水平均低于对照组（P＜0.05）；观察A 组、B 组血钙、血镁、24 h 尿钙、25(OH)D3、PTH 水平与对照组比较，差异有统计学意义（P＜0.05），观察A 组血镁、PTH 水平低于观察B 组（P＜0.05）；观察C 组、D 组血钙、血镁、D3[25(OH)D3]、PTH 水平与对照组比较，差异有统计学意义（P＜0.05）；骨质疏松组25(OH)D3、PTH、HbA1c、病程与骨密度正常组、骨量减低组比较，差异有统计学意义（P＜0.05）。结论2 型糖尿病患者均存在不同程度骨代谢异常情况，具体表现为维生素 D 水平降低，PHT 水平明显偏高，骨密度下降等，其中以血糖水平控制差者和糖尿病病程长者最为显著。

Abstract:: Objective To explore the changes of bone metabolism in patients with type 2 diabetes and their relationship with 25-hydroxy vitamin [25(OH)D3], parathormone (PTH). Methods A total of 350 patients with type 2 diabetes were selected as observation group in this study. ① According to their courses of disease, they were divided into group A(≤10years, n=190)and group B (>10 years, n=160). ②According to glycolsylated hemoglobin (HbA1c)levels, they were divided into group C (<7%, n=205) and group D (>7%,n=145).③According to the amount of bone mineral density (BMD),they were divided into normal group(n=102), osteopenia group (n=161), and osteoporosis group (n=87). A total of 180 healthy people were selected as the control group. BMD was measured by using dual energy X-ray absorptiometry. Levels of blood calcium, phosphorus, magnesium, alkaline phosphatase, 24 h urinary calcium, 25(OH)D3, PTH were detected. Results The levels of 25(OH)D3, blood magnesium, BMD of femoral neck, BMD of total hip in the observation group were lower than those in the control group (P<0.05).The levels of 24 h urine calcium, blood magnesium, blood calcium, 25(OH)D3, PTH in group A and group B were significantly different compared with the control group (P<0.05).The levelsof blood magnesium and PTH in group A were lower than those in group B (P<0.05).The levels of blood calcium, blood magnesium, 25(OH)D3, PTH in group C and group D were significantly different compared with the control group (P<0.05).The levels of 25(OH)D3, PTH, HbA1c, course of disease in osteoporosis group were significantly different compared with normal group and osteopenia group (P< 0.05).Conclusions Type 2 diabetes patients have different degree of bone metabolic disorders, such as lower vitamin D level, higher PTH level, lower BMD. Patients with bad controlled blood glucose or longer courses of disease are more significant.

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《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

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